Technique

In order to prevent unnecessary irradiation of the orbits and especially the lenses, Head CTs are performed at an angle parallel to the base of the skull. Slice thickness may vary, but in general, it is between 5 and 10 mm for a routine Head CT

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Head
General Hints Topogram: Lateral, 256 mm. Patient positioning: Patient lying in supine position, arms resting againstbody, secure head well in the head holder, supportlower legs. Gantry tilt is available for sequence scanning. However, image artifacts may occur if spirals are acquired with a tilt angle greater than 8. For all head studies, it is very important for image quality to position the patient in the center of the scan field. Use the lateral laser beam to make sure that the patient is positioned in the center. In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible. Therefore, patient positioning has to be performed accurately to ensure a centered location of the skull.

Head Kernels
For soft tissue head studies, the standard kernel is H40s; softer images are obtained with H30s or H20s,H10s, sharper images with H50s. The kernels H21s,H31s, H41s yield the same visual sharpness as H20s,H30s,H40s, the image appearance, however, ismore agreeable due to a fine-grained noise structure;quite often, the low contrast detectability is improved by using H31s, H41s instead of H30s,H40s. For the standard head protocols, we proposeH21s, H31s, H41s. For a better gray-white brain tissue differentiation,use the H37f/s,H47f/s or H48f/s . High Resolution head studies should be performedwith H60s, H70s (e.g., for dental and sinuses) andH80s, H90s (e.g., inner ear). It is mandatory to position the area of interest in the center of the scan field.

Scan Protocols- Head Routine

Indications: Spiral mode for routine head studies, for example, stroke, brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc. A range for the base of 4 cm will be covered in 14.3 sec., a range for the cerebrum of 8 cm will be covered in 14.3 sec. kV 130/ 130 Effective mAs/Quality ref. mAs 220/ 240 Rotation time 1.5 sec./ 1.5 sec. Acquisition 16 x 0.6 mm /16 x 1.2 mm Slice collimation 0.6 mm /1.2 mm Slice width 4.0 mm 6.0 mm Feed/Rotation 5.3 mm /10.6 mm Pitch factor 0.55/ 0.55 Increment 4.0 mm/ 6.0 mm Kernel H31s /H31s CTDIVol 58.52 mGy /57.60 mGy Effective dose Male:1.33 mSv/Female:1.43 mSv Male:1.98 mSv-Female:2.21 mSv

Head Neuro: Indications: Special spiral neuro mode for dedicated head studies. Two ranges are predefined for the base of the skull using an acquisition of 16x0.6 mm and for the cerebrum using an acquisition of 4x0.6 mm. A range for the base of 4 cm will be covered in 9.5 sec., a range for the cerebrum of 8 cm will be covered in 62.6 sec.

Head Seq Indications: Sequence mode for routine head studies, e.g., stroke,brain tumors, cranial trauma, cerebral atrophy, hydrocephalus,and inflammation, etc. 2 ranges are predefined for the base of the skull and for thecerebrum.
InnerEarHR Indications: Spiral mode for inner ear high resolution studies, e.g., inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors, post traumatic changes, etc.

Sinus
Indications: Spiral mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc. A range of 80 mm will be covered in 12.4 sec.
For low dose studies use only 20 mAs.

SinusVol
Indications: Spiral mode for axial and coronal paranasal sinuses studies, e.g., sinusitis, mucocele, polyposis, tumor,corrections etc. Three recon jobs are predefined for reconstruction: the first for axial bone structure and the second for the coronal soft tissue in 3D images display view and the third for the coronal bone structure in 3D images display view.

Abdomen: General Hints

Topogram: AP, 512. Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. Respiration: inspiration/expiration.

Oral administration of contrast medium: For abdominal studies, it is necessary to delineate the bowel from other structures such as lymph nodes, abdominal masses & abscesses. Various types of bowel opacifying agents can be used:
- Diluted barium suspension (1%2%) e.g., EZCAT

- Water soluble agent (2%4%) e.g., Gastrografin - Water alone, as a negative contrast agent.

Timing of the oral contrast administration is important

to ensure its even distribution in the bowel.

Upper abdomen: Minimum 500-600 ml of contrast divided into 3 cups (approximately 200250 ml) 1st cup to drink 30 minutes before exam 2nd cup to drink 15 minutes before exam 3rd cup to drink 5 minutes before exam Abdomen-Pelvis: Minimum 1000-1200 ml of contrast divided into 4 cups 1st cup to drink 1hour before exam 2nd4th cups every subsequent 15 minutes Start exam 5 minutes after the 4th cup is administered

In general, for abdominal studies such as liver, gb(query stones), pancreas, GI studies, focal lesion of the kidneys and CTA studies, it is sufficient to use just water. Water is more effective than positive oral contrast agent in depicting the linings of the stomach & intestines in post enhancement studies. In addition, the use of water will not obscure the blood vessels thus allowing CTA processing to be performed easily afterwards. For patients with bowel obstruction, only water or water-soluble contrast can be used. Barium suspension is a contraindication. Be careful when examining pheo chromo cytoma patients. Administration of an IV CM injection in such cases may trigger a hypertensive crisis! To further optimize MPR image quality I recommend that you reduce one or more of the following: collimation, reconstruction increment, and slice width for image reconstruction.

You could repeat the same protocol simply by clicking the chronicle with the right mouse button for repeat; e.g., when both non-contrast and contrast studies are required. Delayed scans may be required for the kidneys & bladder. If you want to use this protocol for a two-phase study, repeat the same protocol and choose start delay time for arterial phase as 20 - 25 sec. In this case, the thin slice reconstruction can also be used for post-processing. Do not administer oral contrast medium, as this impairs the editing of MIP/SSD/VRT images. Water could be used instead if necessary.

Abdomen
Water, rather than positive oral contrast agents should be used.

Give the last cup 200 ml just prior to positioning the patient. To ensure adequate filling of the duodenal loop, lay the patient on the right side for 5 minutes before performing the topogram.
A pre-contrast examination is usually performed only if no CT scans were previously acquired, to exclude calculi in the common bile duct and to visualize possible lesions in the liver. For pancreatic studies, the arterial phase acquisition can be acquired later with a start delay of40 50 sec. It may be necessary to use a thinner collimation.

CT /MRI
CT PICTURE
I.
WHITE MATTER IS DARKER THAN GREY MATTER SINCE LIPID CONTAINING MATERIAL IS RADIOLUCENT
CSF IS BLACK

MR PICTURE
GREY MATTER
T1WI
DARK T2WI BRIGHT

WHITE MATTR

BRIGHT

DARK

CSF

I.

GREY TO DARK

WHITE